The Importance of Collaborative Medicine and Patience

Too many times I have heard patients complain that their doctors and physical therapists gave up on them after only trying one or two things to fix them. Unfortunately, our healthcare system makes doctors so busy that they rarely have much time to actually listen to their patients and spend time with them anymore, leading to missed diagnoses and continued pain. Sadly the country’s healthcare system has turned to drugs to help mask the pain, while leaving the patient with the problem that still remains. We see all these commercials on television for drugs to take for everything and all of a sudden we are convinced that all of our problems will fade away with a “miracle drug”.  The United States is one of the only countries that legalized advertisement of pharmaceuticals on television.  We may find temporary relief with these “miracle drugs”, but if we don’t treat the issue that’s causing it, there’s only so much that drugs will do to stop the pain. The best form of treatment that I will discuss later in this blog is a collaboration between health care providers with a mixture of medications needed for pain and inflammation reduction that coincide with physical therapy treatments to rid the pain and it’s causative factors completely. 

As a patient and physical therapist, I have experienced the realities of our disaster of a healthcare system.  As a patient, I was at the dentist and had to get a crown, which can be very painful.  After I was done with the appointment, they gave me a prescription for a high dosage of Vicodin, an addictive narcotic, which was completely unnecessary.  I also went to the doctor for a strep test because my throat was in severe pain and he offered me a prescription for Hydrocodone and pushed me to take it.  I was shocked at how easily available these narcotics are to people.  It’s like they hand them out like candy because people want a quick fix or way to mask the pain.   As a physical therapist working in Racine, WI, I actually had a patient call to tell me that her doctor told her she was getting too old for physical therapy and to just take pain pills to ease her pain.  This patient constantly complained that she was in pain and it was almost as if she didn’t have the patience to get better so she wanted an instant fix.  Now if you understand research on aging, you would know that nobody is “too old” to gain muscle and ease pain by getting stronger and increasing flexibility.  It may take longer to get the results secondary to the aging process; however, it is possible to still achieve good results.    I continue to be shocked at how much we turn to the pharmaceutical company these days.  It is truly sad how much advertisements sway our beliefs and how much we depend on medications to get us through the day.    

I believe that some medications are very helpful and necessary for helping heal ailments and reducing the inflammatory process; however, we tend to depend on them too much for temporary pain relief instead of working hard to fix it completely.  The best use of medications is in collaboration with other treatments.  So many people are looking for that “quick fix” and easy way to feel better instantly.  What they don’t understand is that the quick fix they are looking for only lasts temporarily without some other form of treatment that actually is geared towards fixing the actual problem.  The patient has to put in a little work and possibly endure some pain along the way to get the best results.  Patience is the key in rehabilitation, along with trusting the therapist. If you’re willing to put in the work, it goes a long way. 

 A good physical therapist will make sure to assess the whole picture and not only treat the area that is causing pain, but understand what caused it originally and ensure that gets fixed as well.  At Monona Rehabilitation Services, I strive to find the root of the pain and treat with a “whole-body” approach, instead of just recommending ways to mask the pain and discharging them when they no longer feel pain.  If someone no longer feels pain, it doesn’t mean they still don’t have impairments that can make it return in the near future.  If I discharged them too early with remaining impairments that led to the problem at hand originally, my patients would be back again and again.  Now, as much as I would love the business, I would much rather see my patients healed than want them back in the clinic with the same issue because whatever caused it wasn’t fixed the first time.  It is a pet peeve of mine when my patients complain that past physical therapists they had gave up on them because they couldn’t figure out what was wrong within a few weeks.  Now this can happen if all the possibilities of treatment have been exhausted (there are A LOT!) and nothing seemed to work, however, it is highly unlikely that they tried everything because this will take a very long time.  To be completely honest with you, physical therapy is trial and error based on immense amounts of research.  We practice based on evidence that is strongly supported by years of research and if that doesn’t work, we try another research-supported approach.  Like I said, there are several approaches to treating patients and since every patient is different, some things won’t work on every person.  Not only is it important for the patient to have patience, but it is equally important for the therapist to be patient in order to find the best approach for each person they treat. 

 I have ranted about a lot in this blog; however, please understand I am in no way trying to bash doctors or other physical therapists.  There are some very good doctors and physical therapists out there that will take the time to listen and help you find the answer that you need.  Every therapist and doctor is different and has different approaches to treatment.  What I wanted to present to you was the sad truths of the healthcare system and the unfortunate beliefs that are created so people get that “quick fix”.  To be completely honest with you, there really is no “quick fix” that lasts.  Like I have discussed in the past, pain is your body’s natural “check engine” light that needs to be assessed.  It is a signal that your body presents to you to tell you that your tissues are in danger.  If you just mask that signal with only pain medicine, the problem will persist and only get worse over time leading you to need even more medicine to “mask” the pain.  It really is a vicious downward cycle if not treated correctly. 

If you take the patience to come to physical therapy, we can help you get rid of that pain for good and I will help ensure that it doesn’t come back.  I had a patient in her 70’s that had knee pain since 1995 when she got her knee replaced.  She came to see me a couple of months ago after dealing with the pain for so long and within a week of putting her on a regular strengthening and stretching program, she was pain-free.  It takes some work, but it’s totally worth it.  She can defend that statement and is happier than she has been in awhile.  Her family has noticed a huge difference in how she walks and even transfers in and out of a chair or the car. 

The best way to get results you want and need is a collaborative approach between doctors and physical therapists, as well as personal trainers and other healthcare workers that are necessary in the plan of care.  Working together, we can help create a unique treatment program geared towards you.  It may combine pain medications temporarily to help ease pain and reduce inflammation, but you must know there is no “quick fix”.  If your therapist or physician is unsure of what to do next, it is perfectly acceptable for them to refer you to someone else that is more specialized in the area. After all, knowing their weaknesses and limitations makes them a better healthcare worker and helps ensure you get the proper treatment you deserve.  If you’re ready to take the next step in getting rid of your pain completely with a collaborative approach and have the patience to do so, come see us today and let me help you get back to what you strive to do pain-free!

Call us at 608-222-2325

Work Place Ergonomics 101

I have had several people complain to me that they sit for a huge portion of the day for work.  As more and more desk jobs arise, I have an increase in the number of patients with neck and back pain related to sitting at work.  Along with these issues, I also hear about “Carpal Tunnel Syndrome” and so many people I know have had surgery to correct this chronic injury, however, it can come back if the main source of the problem is really stemming from the neck and sitting posture.  Other injuries associated with poor posture include, but are not limited to, elbow and wrist tendonitis, shoulder pain and impingement, disc herniations, and sciatic nerve irritation. Below I will discuss proper sitting posture, as well as suggestions for promoting this during the work day.  Also, I will let you know the benefits of seeing a physical therapist for injuries related to poor posture. 

First off, I will review sitting posture that I talked about in the last blog about body mechanics, but I will show a picture below of proper sitting mechanics while at a desk that I found from a website on Google. (http://www.fitsugar.com/Sitting-101-Desk-Ergonomics-1669975)

• Adjust your chair so your hips are resting between 90-120 degrees.  If your feet do not touch the floor, you will need to use a foot rest.  (books tend to work nicely)
• Make sure your lower back is supported promoting its natural curve as shown above.  A lumbar roll or rolled up towel will do the trick. When your low back is in good alignment, it promotes positive aligment above and below. 
• Elbows should be bent between 90-120 degrees with your arms next to the side of your body.  Wrists should be straight, so your keyboard and chair height may need to be adjusted to promote this alignment.
• Ears should be in line with your shoulders and your shoulder blades should be squeezed gently together to promote an upright posture, as discussed in last week's blog. 
• Keep objects you use the most closest to you, so you are not repetitively reaching for them and straining your arms and neck. 
• I suggest getting a headset for your phone if you answer a lot of phone calls to decrease the likelihood of injuring your neck. 
• The top of your computer screen should be at eye level so you don't have to continuosly flex your neck downward to look at it. 
• Avoid crossing your legs during the day for prolonged periods of time because this interrupts proper pelvic and back alignment and can cause injury to occur. 

These are all good suggestions on how to improve sitting posture throughout the day.  Keep in mind, however, that sitting for longer than 30 minutes is tough on your body.  Pain is felt when your body senses danger.  Everybody senses pain differently and at varying intensities, depending on your body's perception of danger.  Sensors in the body send signals to your brain telling you to do something about this pain you are having. Most office workers and people that sit for prolonged periods throughout the day may sense pain mainly because of lack of movement. Your body was made to move and in order to flush out the waste products your body creates throughout the day, you need to move to increase blood flow to your muscles and rid these waste products.  It may sound silly, but even just making a bunch of random movements in your office during the day is better than sitting completely still for hours upon end.  Every 15 minutes or so you should get up and stretch or walk around your cubicle or office.  If you feel pain, listen to your body and move around.  If you ignore it, it can result in the injuries I listed above.  Below are some gentle quick exercises you can perform to increase movement throughout the day.

• Shoulder shrugs - Move your shoulders up and down, as well is in a clockwise or counter-clockwise pattern.
• Neck stretches - Gently move your neck in all directions to help increase mobility throughout the day. (neck circles work nicely!) Tilt it to the side for 30 seconds and then to the other side to stretch the upper trapezius muscle at the top of your shoulders. 
• Shoulder blade squeezes - Gently squeeze shoulder blades down and back and tuck your chin so your head lines up with your shoulders as discussed in my first blog post about body mechanics.
• Ankle pumps - Move your ankles up and down and around in circles to increase blood flow to your legs. 

If you have pain that won't go away with movement or stretching, or have any numbness or tingling in your arms or legs, it is recommended that you seek intervention to prevent further injury from occuring.  Like I said earlier, your body is in pain because it senses danger, so think of it as a warning sign that you need to get it fixed.  If your "check engine" light in your car goes off, you get it looked at right? Otherwise you don't know what could happen...your car could break down and you could get stranded somewhere...the possibilities are endless. Think of this pain as your "check engine" light....go get it looked at and prevent what could happen in the near future! You only get one body, so you wanna be sure it lasts a long time.  Below I will list some of the benefits to coming to physical therapy for this pain that you may be experiencing.

Benefits of PT:

• We evaluate the whole picture and not only treat the issue at hand, but find what caused it and prevent it from happening again by mobilizing joints, improving flexibility and strength, and educating patients on prevention and the overall plan of care.
• We educate patients about their pain and provide a description of their injury in a way that is easy to understand.  After all, who wants to hear a bunch of big words thrown at them that they don't understand?!
• We provide modalities to relieve pain right away, such as ultrasound, electric stimulation, cervical and lumbar traction, TENS, iontophoresis, and heat/ice. We also give guidelines for icing and heating at home.
• We provide a home exercise program with stretches and strengthening exercises to help relieve pain and prevent it from coming back. 

My philosophy is treating the joints above and below the pain because the body is all connected.  Ankle pain can be coming from the low back, just like pelvic misalignment can cause increased incidence of ankle sprains.  I individualize each plan of care because everyone is different and has a different activity tolerance.  I listen to the patient and base my plan of care off of their needs and goals.  If you want to get back to the activities you want to do without pain and limitations, give us a call today and schedule an evaluation!

608-222-2325

Simple Body Mechanics for Daily Activities

Many patients I have come in with injuries secondary to faulty body mechanics while lifting, shoveling, vacuuming, and other daily tasks that can easily cause back or neck pain.  I spend several sessions reviewing body mechanics with people and they play a huge role in daily life if you want to prevent injury and pain. After all, nobody wants to be in pain. I will review some simple body mechanic facts and ideas, as well as go through certain tasks and describe the best way to go about them to prevent injury from occuring.

First, I will discuss posture because it is a HUGE factor associated with daily pain and chronic injuries.  As people age, they begin to develop a forward head posture and rounded shoulders if they are unaware of their body position while sitting at a computer, school desk, standing to do the dishes, or even while eating at the dinner table. Most people begin to slouch secondary to decreased core strength and it seems "more comfortable" as we get fatigued or even lazy throughout the day. I will admit that as the day goes on, my posture begins to fail because I am tired.  Let's be real here, who doesn't get tired? That is not an excuse though because your body will pay for it later! WeThe key things to keep in mind is that your head should be directly over your shoulders...and when I say this, it means your ears should be located over your shoulders.  Next, your shoulders should be in line with your hips and then your hips in line with your ankles with equal weight on both feet.  This promotes proper posture and helps prevent neck and low back pain from occurring, especially if you are seated or standing for long periods of time during the day for work or daily tasks throughout the house.  A good thing to do is reassess your posture every 15 minutes.  It takes 10 seconds to realize where your body is in space and adjust it accordingly.  If your posture is faulty throughout your life, this leads to changes in the spine, pain, and tight chest musculature.  To put things in perspective, your head weighs about 10-13 pounds and if it is forward at all it can put up to 3x that weight (about 30 pounds) of pressure on the muscles in your neck and upper back.  Just think of all the energy your body could preserve if you had good posture! These things can be prevented with a simple assessment of your posture throughout the day.  If you already have rounded shoulders, it is important to start doing a chest stretch.  Below is a picture of a chest stretch in the corner that can also be performed in a doorway if you place your forearms on the wall or door frame and place one foot in front of the other and lean forward.  This stretch should be gentle and not painful.  Hold for 30 seconds and repeat 3 times up to 2-3 times a day to help decrease rounded shoulders. 

Another exercise that should be performed to help improve posture is sitting up tall and squeezing your shoulder blades down and back, while trying not to extend your lower back and while keeping your chin tucked in so that your ears are lined up with your shoulders.  Machines and exercises that target the middle and lower trapezius muscles, as well as the rhomboids should be used to help promote better posture.  These exercises should get you started on a healthier posture today!


The next thing I will discuss is lifting mechanics.  Many people will use faulty body mechancis to lift an object, even as light as a pencil, however, this can still result in a "bulging disc".  There are "jelly donut-like" structures between each vertebrae in the spine that help absort shock between each bone and these are called intervertebral discs.  People lose up to 3/4 of an inch in height each day as gravity pulls on these discs and drains their water content....but don't worry because you gain your height back when laying down to sleep at night! (Kinda cool, huh??) As time goes on, however, your discs do lose water content and that is why elderly people seem to "shrink" and are shorter than they used to be. Postural changes play a big role in that too....so looks like you better start early on prevention! To prevent yourself from back injury, it is important to follow these simple rules while lifting an object, no matter how heavy it is.  There are two main ways to lift up an object. (See below paragraph for pictures of both strategies) The first way is the bend at the knees with a wide base of support, keeping the object close to your body.  With this strategy, you want to be sure to keep your spine in a neutral position and tighten your abdominal muscles while using your legs to push up from the ground and lift the object.  The second strategy is the "hip hinge".  This strategy can be used if you have painful knees.  To perform this properly, you must keep your back flat and bend completely at your hips while maintaining a slight knee bend.  Again, it is always important to keep the object close to your body.  If you go to lift up a 5 pound object and hold it directly out in front of you, instead of close to your body, it will add up to 10x that weight in pressure on your spine (up to 50 pounds in this case).  Another thing to remember is not to rotate at the spine when holding or moving an object.  Instead of rotating your spine, you should rotate your entire body.  When carrying an object, you should avoid over-extending or over-bending of your low back, as well as shrugging your shoulders in order to keep pressure off of muscles that can easily be irritated.  When pushing or pulling an object, keep in mind that pushing is easier than pulling and you should keep loads close and maintain a neutral curve in your spine while tightening your core musculature.  These simple things can help save yourself from a lifetime of back injuries!

 

Strategy 1: Knee bend               Strategy 2: Hip hinge

Lastly, I will talk about shoveling! For all those people in Wisconsin, we know how this simple task can turn into a nightmare and loads of back pain and sore muscles the next day.  The key things to remember with shoveling, I have already discussed above. Simple to remember then, huh? As a reminder, the main thing is to keep the load close to you, bend at the knees, and don't rotate at your spine.  Most people, me included, have tried to shovel and when tired, we tend to want to just throw the snow by rotating to the side....this is very BAD and creates injuries and sore backs the next day.  Always rotate your entire body if you want to move the snow. Please remember these simple things next time you go out to shovel. 

Hope this was helpful! Please feel free to comment or ask questions. I treat all sorts of neck and back injuries at the clinic here in Madison, so if you need a physical therapist, see your doctor for a script today and let me help you get rid of your pain and prevent future injuries!